This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Wednesday, April 23, 2014

Weekly Overseas Health IT Links - 23rd April, 2014.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

A federally funded study finds that criteria under the electronic health records meaningful use program “fall short of achieving meaningful use in any practical sense.” Don’t believe it.

The report contends that interoperability in the meaningful use program is basically meaningless, amounting to “little more than replacing fax machines with the electronic delivery of page-formatted medical records.” And that has some merit, but interoperability isn’t the end-all toward meaningfulness. The report then offers a comprehensive software architecture for Stage 3 of the meaningful use program that would create a truly interoperable health data infrastructure. That’s wonderful if report authors don’t care about what is really feasible for the health care industry during Stage 2 now, and Stage 3 in just three years.

Recent studies have shown e-prescribing to have a host of benefits, including a more streamlined workflow for physicians, a reduction in errors that result from misread handwritten prescriptions and increased patient satisfaction. However, the costs associated with e-prescribing have kept many ambulatory physicians reaching for pen and pad, according to a literature review in Perspectives in Health Information Management.

Progress toward more specific medical data gathering has been halted, once again.

President Obama recently signed the "doc fix" legislation (HR 4302) to delay scheduled cuts to Medicare physician reimbursement rates. The bill also pushes back the ICD-10 compliance date until at least October 2015, further delaying the switch from ICD-9 to ICD-10, which was endorsed by the Forty-third World Health Assembly in May 1990 and released to WHO member states 20 years ago in 1994.

The switch to ICD-10 means that health care providers and insurers will have to replace 14,000 codes with 69,000 codes. These two numbers are often cited by opponents as an undue burden on already busy hospitals and physicians. Terry Gunn, CEO of KershawHealth in South Carolina, said the delay would give hospitals more time to get ready for the "huge, overwhelming task" of ICD-10 implementation. A senior policy adviser to the Medical Group Management Association said that it is "recognition that the industry is simply not ready for the transition."

On the other side, CMS estimates that a one-year delay could cost between $1 billion and $6.6 billion, according to a blog post by the American Health Information Management Association (AHIMA), which opposes the delay. AHIMA also says that the delay affects some 25,000 of its students who have learned to code only in ICD-10, and that it affects "much more than just coded medical bills, but also quality, population health, and other programs that expected to start using ICD-10 codes in October." CHIME's president criticized Congress, saying, "Further delay of ICD-10 discredits the considerable investment made by stakeholders across the country to modernize health care delivery."

To help create a new health-information architecture, the current crop of electronic health-record systems needs to be connected using interfaces that will allow them to communicate with each other, according to recommendations from a group of U.S. scientists reporting on the nation's health-information interoperability needs.

The scientists' group, known as JASON, produced a 65-page report, under contract with the Agency for Healthcare Research and Quality at HHS, advocating health IT infrastructure that provides “a migration pathway from legacy EHR systems,” the report stated. It calls for federal mandates to use what are known as application programming interfaces, or APIs, to connect legacy systems to each other.

“This pathway could be provided by published APIs mandated through the CMS Stage 3 Meaningful Use program,” the report's authors said.

When federal agencies hold a three-day public meeting next month to get feedback from stakeholders on their health IT report, one technology area that will no doubt garner prominent discussion is mobile medical applications. Though the draft report developed by the Food and Drug Administration, in consultation with the Office of the National Coordinator for HIT and the Federal Communications Commission, contains a proposed strategy and recommendations for a risk-based regulatory framework for health IT, it says very little about mobile technology.

Section 618(a) of FDASIA explicitly directed that the agencies publish a report to Congress that includes mobile medical apps. However, the document simply summarizes in a single paragraph the essence of the FDA's 43-page September 2013 final guidance on mobile medical apps, reiterating the regulatory agency's "narrowly focused approach" to oversight of these products and its intention to concentrate on a "small subset" of the app market--only those apps that present the greatest risk to patients if they do not work as intended.

The article, which outlines "10 things your medical records won't say" flags several problems endemic to EHRs that have received a lot of media attention, such as high costs and physicians' dissatisfaction with the systems.

However, several of the problems noted have received less attention and are not readily apparent, especially to consumers.

The most basic security truth in 2014 is that encryption done properly -- a high enough level of encryption, proper safeguarding of the encryption key -- is the best thing an IT department can do.

Sill, many industries resist encryption -- and healthcare is arguably the most strident.

Why? Although the answer changes with the healthcare expert speaking, much of the resistance is based on fear of change. That's not the FDR "fear itself" concern, but fear of what encryption could inadvertently due to sensitive integrated healthcare systems.

Many experts have predicted that digital pathology could have the same kind of impact on pathology services that picture archiving and communications systems and their related technology have had on digital imaging.

The makers of remote sensors and computers will have an eye toward faster, cheaper discoveries and proven value for cost-conscious purchasers.

Technological advances, empowered consumers, disruptive new entrants and rising demand by an aging population are ushering in a new era in health care, according to a report from PricewaterhouseCoopers (PwC).

In what the company calls the New Health Economy, the mere collection of data will be replaced with lightning-fast analysis delivered directly to a care team that anticipates problems before they arise.

The report predicted individuals would be co-creators of their health decisions, spending more of their discretionary dollars on tools that help them live well.

I take exception with the meaningful use Stage 2 vendor hardship exception. In the interest of full disclosure, I am president of a patient engagement company that has successfully secured modular certification for its patient portal/personal health record solution.

From a selfish perspective, it is really galling for those of us who have done the hard work and heavy lifting required for timely 2014 ONC-ACB certification to find out after the fact that those health IT vendors that are not certified can now offer their clients an "out." Likewise, provider organizations that moved mountains to prepare for meaningful use Stage 2 may understandably be frustrated to learn the runway has a rest area. The effort required for a provider to step up from meaningful use Stage 1 to meaningful use Stage 2 is significant. Those using certified technology are now prevented from playing the "vendor not ready" card -- a perverse disincentive to partner with vendors that have done the right thing.

Security is a nightmare for all companies, but the very nature of healthcare makes it far worse. It's not merely onerous government requirements for medical data, or the popularity of security-adverse mobile devices. It's the need to give tiny medical offices – small, independent businesses, with typically no meaningful IT staff – full network access to all files, physical building access to its employees and privileges to change/add to that ultra-sensitive data.

But are there ways to truly make these accesses more secure and to do so in ways that will be not merely viable, but even profitable? Many industry insiders say there are, but only if participants agree to start taking security seriously.

The SMART Platforms project at Boston Children’s Hospital, which is developing an apps platform for healthcare, is shifting into a higher gear with the formation of an advisory committee to guide the organization on strategy, technical approach and business development. All of the organizations represented on the board are working with SMART apps.

SMART, which stands for Substitutable Medical Apps & Reusable Technology, has been able to demonstrate that an iPhone-like platform and apps-store approach is viable, said Kenneth Mandl, M.D., M.P.H., a professor at Harvard Medical School and the Boston Children's Hospital Chair in Biomedical Informatics and Population Health. At the most recent HIMSS conference in Orlando, Mandl said, his team saw SMART apps running on multiple EHR systems, such as Intermountain’s homegrown system. (Cerner is also working on SMART apps.) “It is mature enough for organizations to use without our supervision,” he said. “Now we want to bake it into customer demands and have more demonstrations of its use and more apps created,” Mandl said. The advisory committee will help SMART develop some concrete projects in the medication management space. “They will help us find the channels and amplify our voice.” They may also help define a governance model for app standards, he added.

With consumers entranced by fast-evolving technologies and accustomed to price competition, healthcare is set to be transformed by innovations from other sectors of the economy such as retail and telecommunications, according to a new study by PwC's Health Research Institute.

In Healthcare's New Entrants: Who will be the industry's Amazon.com?, PwC suggests that "market disruptors" -- new industries, new technologies -- will soon make a big mark on the $2.8 trillion healthcare sector.

These new players are the leading edge of a what PwC calls a "new health economy" -- one that "over the next decade will see today's siloed healthcare industry become a wide open health marketplace," said Kelly Barnes, PwC's U.S. health industries leader, in a press statement.

NHS England has unveiled the details of the GP projects that will benefit from the £50m Challenge Fund to improve access to primary care.

The commissioning board says that 7m patients will benefit from the 20 pilot schemes, most of which focus on grouping traditional practices into networks that can offer single points of access in the evenings and at weekends.

A number of the projects add single point of contact telephone numbers, apps offering advice on how to contact appropriate services, email and Skype ‘appointments’ and telehealth to the mix.

For example, six GP surgeries in Wakefield will work together to offer an 8am to 8pm service, seven days a week, supported by an “online signposting service to give patients better access to GP and other community services”, email appointment booking, and real-time phone and web chats.

Privacy has the potential to crash big data before there's a chance to get it right, and finding the right balance is key to future success, experts argued at a Princeton University event earlier this month.

The event, titled "Big Data and Health: Implications for New Jersey's Health Care System" featured four panels exploring health, privacy, cost and transparency in regard to how big data can improve care and patient outcomes, according to an article on the university's website.

"Privacy will crash big data if we don't get it right," Joel Reidenberg, visiting professor of computer science at Princeton and a professor at Fordham University's School of Law, said at the event.

Implementing telehealth can be both threatening and disruptive to nurses and technical staff, thus managers and service providers should develop strategies to minimize these reactions.

These insights were gleaned from a longitudinal qualitative study—published in the BMC Health Services Research —which followed the implementation of a telehealth service at a United Kingdom-based provider. The study involved extensive focus group discussions with congestive heart failure nurses, chronic obstructive pulmonary disease nurses and community support workers on their perspectives on the telehealth adoption.

Sure, the EHR Incentive Program – with its $22 billion paid out thus far to meaningful users – might have helped bring the healthcare sector out of the Dark Ages and into the 21st Century, but do these systems really improve the quality of patient care?

For the most part, a new study says, 'no'.

Researchers at Harvard Medical School and Brigham and Women's Hospital compared physician performance across seven Stage 1 quality measures for five chronic diseases between providers who demonstrated meaningful use of electronic health records and those who did not.

Showing meaningful use (MU) of electronic health records (EHRs) was not correlated with performance on clinical quality measures, according to a new study published online April 14 in JAMA Internal Medicine.

The study, one of the first of its kind, was performed at clinics affiliated with Brigham and Women's Hospital in Boston, Massachusetts. It compared the quality scores of 540 physicians who achieved MU with those of 318 physicians who did not. The healthcare organization computed quality scores on MU measures for all of the 858 physicians, but only some of these physicians met all of the criteria for the government incentive program during the 3-month study period.

Lipika Samal, MD, MPH, from the Division of General Medicine and Primary Care, Brigham and Women’s Hospital, and colleagues looked at 7 metrics for 5 conditions: hypertension, diabetes, coronary artery disease, asthma, and depression. "[MU] was associated with marginally better quality for 2 measures, worse quality for 2 measures, and not associated with better or worse quality for 3 measures," the authors state.

National Coordinator for Health IT Karen DeSalvo wants to see changes made to the Health IT Policy Committee's current "somewhat siloed" workgroup structure. In a meeting last week of the HIT Policy Committee, DeSalvo called for fewer workgroups but expansion of their scopes so that they are more "strategic and forward-thinking" with the restructuring slated to begin in May for a couple of the workgroups and the rest of the transition continuing this summer.

The HIT Policy Committee workgroups meet periodically to address important policy questions, present findings at committee meetings, and make recommendations to the committee. The workgroups that DeSalvo has proposed include: HIT Strategic Planning; Advanced Health Models and Meaningful Use; HIT Implementation, Usability and Safety; and Interoperability and Health Information Exchange. She said the privacy/security and consumer workgroups will continue in a "matrix conversation" with the other workgroups.

The 62 health IT regional extension centers have far exceeded their goal of helping 100,000 providers in small primary care practices attest to the meaningful use of electronic health records. As of March 4, more than 150,000 providers had enrolled with RECs. Of those providers, 90% had gone live on their EHRs and more than 93,000 had demonstrated meaningful use, according to the Office of the National Coordinator of Health IT.

An ONC report to Congress in June 2013 pointed out that nearly half of the providers who received Medicaid EHR incentive payments and a fifth of those that got Medicare incentives had enrolled in RECs. Moreover, Medicare providers who worked with RECs were 2.3 times more likely to receive an EHR incentive payment than those who didn't.

Based on these statistics, ONC views the REC program as a success. But it's unclear where the RECs will go from here.

While federal funding for the RECs officially ended on April 15, ONC is allowing the RECs to request "no-cost," one-year contract extensions that will enable them to use any remaining money in their budgets for specified purposes. At latest count, 55 RECs had asked for these extensions and 39 had received them, although other requests were still pending.

Scott Mace, for HealthLeaders Media , April 15, 2014

A tech investor with a proven track record of attracting innovation and money to a variety of endeavors is looking for a few good communities to compete for the greatest improvement in five measures of health and economic vitality.

Healthcare ladies and gentlemen, start your communities.

That was the call on April 10 from angel investor and tech advisor Esther Dyson, whose population health dream has taken a big step toward reality with the launch of the Way to Wellville competition.

From now until May 23, Dyson's nonprofit startup, HICCup, is inviting communities to apply to be one of five contestants in a five-year-long competition to get healthy using everything from the latest fitness gadgets to reality TV. Dyson is HICCup's founder and chairman of EDventure Holdings.

Many healthcare organizations migrating information systems to a cloud-hosted service struggle developing an appropriate strategy for the task, says Ed King, managing director of healthcare consulting services at disaster recovery and cloud-hosting vendor Sungard Availability Services. The Wayne, Pa.-based company split from software and processing services vendor SunGard in March and became an independent entity.

Moving to the cloud is not just a new way of doing computing-on-demand; it’s also a new way for personnel in an organization to use the technology. Almost always, not every system moves to the cloud, particularly legacy systems, King notes. There are a growing number of electronic health records systems and newer ancillary products being cloud-hosted by a remote vendor, while older secondary systems--back-office, financial, pharmacy and laboratory, for instance--may tie to cloud-based systems but remain in-house. And, some other systems may stay in-house as they need a dedicated server because of how they are coded. The result for providers is that new processes and skill sets are needed to manage a hybrid environment, and the vendor can assist in putting together the plan for cloud computing.

With consumers entranced by fast-evolving technologies and accustomed to price competition, healthcare is set to be transformed by innovations from other sectors of the economy such as retail and telecommunications, according to a new study by PwC's Health Research Institute.

In Healthcare's New Entrants: Who will be the industry's Amazon.com?, PwC suggests that "market disruptors" -- new industries, new technologies -- will soon make a big mark on the $2.8 trillion healthcare sector.

These new players are the leading edge of a what PwC calls a "new health economy" -- one that "over the next decade will see today's siloed healthcare industry become a wide open health marketplace," said Kelly Barnes, PwC's U.S. health industries leader, in a press statement.

The ECRI Institute Patient Safety Organization is calling for collaboration on patient safety to create a "a non-punitive learning environment" to bring about improvement.

Its Partnership for Promoting Health IT Patient Safety, it recently announced, will involve healthcare providers, health IT vendors, professional societies and patient safety organizations in creating a national framework for identifying and addressing health IT safety issues.

A new study has shown that the quality of the information related to the diagnosis and treatment of physical disease or injuries available on web searches could be hazardous to health.

According to University of Florida researchers, web searches related to physical disease or injuries tend to yield higher-quality information than online searches for preventive health and social health information, and when it comes to health information, search results may vary.